Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand.

Introduction: Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition. Material and Methods: A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD). Results: Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities. Conclusion: Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Change in Apo B100/A1 Ratio in Children With Epilepsy on Monotherapy With Sodium Valproate, Oxcarbazepine or Levetiracetam.

A prospective longitudinal study was conducted to assess the Apo B100/A1 ratio as a marker of cardiovascular risk in children with epilepsy aged 5-14 years on long-term anti-seizure medication monotherapy with either sodium valproate, oxcarbazepine, or levetiracetam. Apo B100/A1 ratio showed an increase after six months of monotherapy with oxcarbazepine (P=0.05).

Oral Dexamethasone versus Prednisolone for Management of Children with West Syndrome: An Open-Labeled Randomized Controlled Pilot Trial.

Objective: To compare the efficacy of oral dexamethasone and prednisolone in the treatment of newly diagnosed children aged 3-36 months of West syndrome. Methods: An open-labeled, randomized controlled clinical trial with parallel group assignment was conducted among children aged 3-36 months with newly diagnosed West syndrome. They were randomized to receive either oral dexamethasone (0.6 mg/kg/day QID) (n = 20) or oral prednisolone (4 mg/kg/day BD) (n = 20). Proportion of children who achieved spasm freedom at 2 weeks was the primary outcome. Secondary outcome measures were proportion of children who achieved electroclinical resolution, greater than 50% reduction in spasms frequency, time to cessation of spasms, and adverse effects at 2 weeks. Results: The efficacy of oral dexamethasone was comparable to oral prednisolone in terms of proportion of children who achieved spasms cessation (13 [65%] vs. 8 [40%]; P = 0.21), electroclinical remission (13 [65%] vs. 8 [40%] P = 0.21), greater than 50% reduction of spasms (3 [15%] vs. 7 [35%] P = 0.65), and time to cessation of spasms (5.31 [2.81] vs. 4.37 [1.41] P = 0.39). Adverse effect profile was also comparable with irritability (18 [90%] vs. 12 [60%] P = 0.06] being most common. Conclusion: There was no difference in electroclinical remission at 2 weeks between oral dexamethasone and prednisolone in children with infantile spasms in this small pilot trial. Further evaluation is suggested with an adequately powered study and long-term follow-up.

Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial.

BACKGROUND: There is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC). OBJECTIVE: To compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC. STUDY DESIGN: Open-labelled randomized controlled trial. PARTICIPANTS: Children aged 1-14 years with newly diagnosed active neurocysticercosis. INTERVENTION: Albendazole (15 mg/kg/day) for either 14 days or 28 days. OUTCOME: The primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging. RESULTS: 65 children with newly diagnosed NCC were rando-mized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51-16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59-5.99); P=0.39] were also comparable. There were no major side-effects noted during the study. CONCLUSION: 14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up.

Evaluation of efficacy of skin cleansing with chlorhexidine in prevention of neonatal nosocomial sepsis - a randomized controlled trial.

AIM: The aim of this study was to evaluate the efficacy of skin cleansing with chlorhexidine (CHD) in the prevention of neonatal nosocomial sepsis - a randomized controlled trial. METHODS: This study design was a randomized controlled trial carried out in a tertiary care center of north India. About 140 eligible neonates were randomly allocated to either the subject area group (wiped with CHD solution till day seven of life) or the control group (wiped with lukewarm water). The primary outcome studied was to determine the decrease in the incidence of neonatal nosocomial sepsis (blood culture proven) in the intervention group. RESULTS: Out of 140 enrolled neonates, 70 were allocated to each group. The ratio of positive blood culture among the CHD group was 3.57%, while the ratio of positive blood culture among the control group was 6.85%. There was trending towards a reduction in blood culture proven sepsis in the intervention group, although the remainder was not statistically significant. A similar decreasing trend was observed in rates of skin colonization, duration of hospital stay, and duration of antibiotic treatment. CONCLUSION: CHD skin cleansing decreases the incidence of blood culture sepsis and could be an easy and cheap intervention for reducing the neonatal sepsis in countries where the neonatal mortality rate is high because of sepsis.

Immunocontraceptives: How far from reality?

Despite high expectations of safer, effective, economical, longer acting contraceptives, to date, there are no licensed contraceptive vaccines available in the market. Nevertheless, a role for vaccines undoubtedly exists as an aid to birth spacing and as a nonsurgical means of generating sterility. The research concerned in the area so far has been successful on the feline population, with room still for exhaustive studies on humans. The future of contraceptive vaccines holds great promise in terms of comfort, price, efficacy, rare complications, and possibly nonselective action on animal populations as well as on humans. This brief review deals with the basic aspects of immunocontraceptives along with the efforts done so far. There is a need for further research in aspects involving the rate of evolution of contraception resistance based on genetics, resistance phenotypes, or cross generation effects. Gonadotropin-releasing hormone and luteinizing-hormone have not been investigated in humans, as both reported impotency in animals; the follicle-stimulating hormone has been shown to cause oligospermia; zona pellucida has also not been studied in humans as it causes irreversible oophoritis, while the sperm has the potential for success in humans based on the data from immunoreproductive studies. Even as the position of the human chorionic gonadotropin vaccine looks hopeful, research on other possible targets continue with an eventual aim of discovering a vaccine that is more immunogenically effective.

Morbidity profile and seasonal variation of diseases in a primary health center in kanpur district: a tool for the health planners.

OBJECTIVE: The objective of this study was to determine the morbidity profile of patients being treated at the Primary Health Center, their distribution according to gender, and the seasonal trend of diseases. MATERIALS AND METHODS: The study was done retrospectively using secondary data, over a period of 1 year from June 2007 to July 2008, at the OPD of the Primary Health Center at Patara in Kanpur District, India. The study was aimed to study the pattern of diseases according to the classification provided by the Government of India. The data were collected from the OPD registers of the consultant medical officer, and the diagnosis was classified into communicable diseases, nutritional and metabolic disorders, infectious diseases, obstetric complications, and other diseases including injuries. RESULTS: A total of 6838 patients had been treated at the OPD, which included 2707 males and 4131 females. It was observed that, while communicable diseases constituted about half of the total burden of the diseases with skin infections being the commonest; the non-communicable diseases constituted about one-fifth of the total disease burden. Significant gender differences were evident in the prevalence of certain diseases such as worm infestation, acute respiratory tract infection, urinary tract infection, reproductive tract infection, chronic obstructive pulmonary disease, gastritis, arthritis/gout, falls/injuries/fractures, anemia, pyrexia of unknown origin, and snake bite. Most of the diseases were observed to have a seasonal variation, with the communicable and infectious diseases peaking in the monsoon months. Surprisingly, the non-communicable diseases such as gastritis and falls and injuries also showed a seasonal variation. CONCLUSION: Many diseases have a seasonal variation and the burden of these diseases could be reduced if we devise measures to detect the changes in their trend through the implementation of surveillance programs in this part of the world, as has been carried out in other countries. The knowledge of the burden of the diseases would also assist the health administrators in judicious allocation of the resources.

Proteomics in obstetrics and gynecology.

Proteomics helps to understand the basic biological processes critical to normal cellular functions as well as the development of diseases. It identifies the essential components of these processes and exploits these components as targets in the development of new methods to prevent or treat diseases. Proteomics, although in an infancy stage in India, has the potential to complement and further enlarge the wealth of information in medicine, especially in the field of cancer. This article reviews the recent progress in proteomic techniques and their applications in the field of obstetrics and gynecology.